Purpose: To determine the influence of pneumoperitoneum on respiratory function during urological laparoscopic surgery.
Materials and Methods: We performed laparoscopic surgery on 82 patients, 45 of these patients were examined in detail of the effect of pneumoperitoneum on the respiratory function. Of these 45 patients, 14 patients received lymphadenectomy and 31 patients received adrenalectomy. For comparative analysis, 4 patients with laparoscopic cholecystectomies were also examined. Under general anesthesia, carbon dioxide tension (PaCO₂) was analyzed before, during, and after the pneumoperitoneum. The data were analysed along with 4 factors; the patient's spirographic parameters, alveolar-arterial gas difference (AaDO₂), insufflation pressure for the pneumoperitoneum, and operating time.
Result: After starting the pneumoperitoneum, PaCO₂ levels rose significantly. The PaCO₂ levels of patients underwent laparoscopic adrenalectomy were higher than that of patients underwent laparoscopic cholecystectomy. The preoperative vital capacity and forced expiratory volume in one second (FEV_1.0) did not show a significant difference of increase in the degree of PaCO₂ increase. In contrast, the important factors that were closely related to the elevation of PaCO₂ were preoperatie AaDO₂ and intraoperative insufflation pressure. Patients with high preoperative AaDO₂ (>10 torr) showed a significant increase in PaCO₂ levels after pneumoperitoneum. When insufflation pressure was high (>=10mmHg), there was a significant rise of PaCO₂ after peumoperitoneum. In all patients whose operating time was 300 minutes or more, high levels of PaCO₂ continued on the next day after surgery.
Conclusion: We should still carefully observe the insufflation pressure, operating time, and other ventilation conditions during laparoscopic surgery.

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To clarify the pathogenesis of calcium-containing urinary stone, calcium metabolism of the 113 patients with calcium-containing stone was studied by fasting and oral calcium loading test. The stone patients were classified into four groups. Those were normocalciuria (NC, n=60), absorptive hypercalciuria-1 (AH-1, n=26), absorptive hypercalciuria-2 (AH-2, n=16) and renal hypercalciuria (RH, n=11).
In the AH-1 group, hypercalciuria resulted from enhancement of intestinal calcium (Ca) absorption. The increase in serum Ca from absorbed Ca increased renal filtered load of Ca. Urinary excretion of Ca was correlated to that of sodium (Na) in fasting and Ca load, and both increments were also correlated in Ca load. As of this fact, the increase in Na excretion was responsible for a cause of hypercalciuria in the AH-1 group.
In the RH group, the serum ionized Ca level and % tubular reabsorption of Ca were significantly lower than those of other groups. Urinary excretion of Ca and Na ratio was significantly higher than that of the NC and AH-1 groups. This condition was due to an impaired renal tubular reabsorption of Ca and the resulting secondary hyperparathyroidism. These findings suggested was response disorder of distal tubular to parathyroid hormone.
Urinary excretion of phosphorus (P) was correlated to that of Na in fasting and Ca load, and both increments were also correlated in Ca load in the AH-1 group. The increase in urinary excretion of P resulted from the secondary hyperparathyroidism in the RH group. Finally, a tendency was noted that stone formers excreted the more Ca, the more P. But in all groups with increased Tmp/GFR in Ca load, it was normal response of proximal tubular to parathyroid hormone.
In the AH-2 group, cause of hypercalciuria was not clarified.

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We investigated prognosis of clinically localized prostatic adenocarcinoma patients who revealed to have had lymph nodes metastases by undergoing radical surgery. Eighty six patients were operated during the last 15 years under the clinical diagnosis of A2, 9 patients, B1, 15 B2, 13 and C, 49, respectively. Total prostatectomy was done to 51, total cystoprostatectomy to 33 and total pelvic excentration to 2 patients. Of these patients, 22.2% with stage A2, 20.2% with B1, 7.7% with B2 and 43.8% with C had positive nodes and the rate of positive nodes in stage C was significantly higher than that in other stages (p<0.01). Regarding histological differentiation, 15.4% of well, 23.7% of moderate and 51.6% of poor by differentiated had positive nodes and the rate of positive nodes in poor by differentiated was significantly higher (p<0.01). In 2 of 21 cases whose lymph nodes were dissected to the level of the aortic bifurcation, positive nodes were detected only in the external and common iliac areas. These two cases were missed, i. e., “false negative” if limited nodes dissection was performed. All patients with positive nodes were treated with hormonal therapy. The 5-year cancer specific survival rate of patients with positive (n=27) and negative (n=59) nodes were 66.4% and 92.4%, respectively. The prognosis of patients with positive nodes were significantly worse than that of patients with negative nodes (p<0.001). Among 27 patients with positive nodes, significant prognostic factor was not number or extent of positive nodes, but histological differentiation.
These data suggest radical surgery with hormonal therapy may improve survival in the patients with positive nodes whose histological differentiation is well or moderate.

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Thirty-three patients who had transitional cell carcinoma of the bladder with stage PT1 and grade 3 components were treated between January 1980 and December 1992. Clinical study was done for these 33 patients on treatment modalities and it's problem, intravesical recurrence, disease progression and prognosis.
Twenty-five of 33 patients underwent bladder-sparing surgeries and total cystectomy was performed for another 8 patients as initial treatment.
Intravesical recurrence was observed in 18 (72%) of 25 patients who underwent initial bladder-sparing surgeries. Recurrence-free rate was 44% for 1 year and mean period to recurrence from initial therapy was 13.1 months. Although some adjuvant therapy after initial treatment was performed for 20 patients, it's efficacy in preventing intravesical recurrence could not be confirmed.
Disease progression was recognized in 10 (40%) of 25 patients initially treated by bladder-sparing surgeries after median latent period of 33.7 months, whereas only one (12.5%) of another 8 patients who underwent total cystectomy showed progression, and 5-year progression-free rate after initial bladder-sparing surgeries was 55.6%.
Three and five-year actural survival rate in all cases were 81.5% and 65.1%, respectively.
According to initial treatment, 5-year survival rate was 62.2% for the patients treated by bladder-sparing surgeries, whereas it was 83.3% for the cases who underwent total cystectomy. However statistical significant difference was not recognized.
In view of disease progression after initial bladder-sparing surgeries, patients with progression yealed a 45.7% 5-year survival rate compared to 81.5% for the patients without progression, and significant difference was demonstrated between them.
These results suggested that radical surgery should be recommended with proper timing for the patients with pT1G3 tumors before progression, because the prognosis is very poor, when they show progression.

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Background factors, which are causes of functional and organic impotence, of 729 impotent patients over 50 years old were evaluated. They were classified into 3 major categories, i. e., stresses at job, stresses at home, and diseases or accidents. Over 30% of the patients had 2 or more categories. A retirement from office and troubles at job were most frequent among stresses at job. As to stresses at home, marital problems such as wife's death and remarriage were most common. With respect to diseases or accidents, they were observed in 84 percent of all patients, and hypertension (HT) or diabetes mellitus (DM) were most common and the rate of medication was considerably high. The percent of clearly organic impotence was quite low (22%).
Hormonal environment of 303 over 50 aged impotent patients was checked and compared with 120 impotent patients from 20 to 49 years old. Serum testosterone (T) levels in patients over 70 years of age decreased significantly. Lutenizing hormone (LH) and follicle stimulating hormone (FSH) levels in patients after age 50 progressively increased. Patients administered anti-androgenic agenst tended to show lower T and higher LH, FSH, and prolactin (PRL) levels than non-administrated. Patients with psychotropic drugs showed significantly higher PRL levels. Hormonal therapy (mainly T replacement therapy) tended to be more effective in patients of low serum T levels before therapy. However, some patients with normal T improved.
In 141 impotent patients, 83 cases of which were after age 50, the degrees of their penile arterial impairment were tested using penile brachial index (PBI) and pulse volume recordings (PVR). PVR waveforms were classified into 3 groups, i. e., normal, slightly abnormal, and markedly abnormal. PBI was significantly lower in abnormal groups than in normal group. Between each parameter of PVR and PBI, statistically significant correlation and relevancy were found. Crest time were significantly longer, and PBI and angle of rise significantly lower in over 50 aged patients than in 20-49 aged. We evaluated the risk factors to penile arterial impairment, such as DM, HT, smoking, and cardiovascular disorders. Each of these risk factors was minor to age factor itself. PVR proved to be useful, simple, and non-invasive method for the screening of vascular impotence.
In conclusion, degenerative changes occur about hormonal environment and penile blood flow according to aging, and many kinds of background factors have direct or indirect influence to occurrence of impotence. We emphasize such matters should be considered at examination of middle-high aged impotent patients.

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A total of 29 patients with advanced renal cell carcinoma entered a pilot study of combination therapy with interferon α(IFN-α) and interferon γ(IFN-γ). IFN-α (HLBI: 3×10⁶ IU, BALL 1: 5×10⁶ IU, IFN-α-2a: 9×10⁶ IU or IFN-α-2b: 6×10⁶ IU) was given intramuscularly every day and IFN-γ (IFN-γ-1a: 3×10⁶ JRU) was given intravenously by drip infusion 3 times a week (every 2-3 days). The treatment was continued for 3 months as the induction therapy, and then the tumor response was evaluated. Of the 22 evaluable patients, 4 achieved a partial response (PR), 10 showed no change (NC), and in 8 the disease had progressed (PD) during the therapy. Thus, the overall response rate was 18.2% [95% confidence interval (CI) 2.1-34.3%]. A favorable response tended to be obtained in patients with good performance status or small pulmonary metastases, or in those who had no prior therapy with IFN-α, who received this treatment immediately subsequent to radical nephrectomy, or who received IFN-γ as much as possible according to this regimen. Toxicity was evaluated in 28 patients: fever, general fatigue, anorexia, leukocytopenia and impaired liver function were frequently noted, and 3 patients were withdrawn from the study because of such adverse effects. In patients who had a PR or NC, the same dosage of IFN-α was continued to be given intramuscularly 2-3 times a week (every 2-4 days) as the maintenance therapy. At present, the median duration of response (PR) is 37 weeks (range: 12-138+ weeks) and the median survival period for the 22 patients is 67 weeks (range: 6-164+ weeks), with 13 cancer deaths. In concluding, we cannot say that this regimen is more effective than IFN-α alone in the present circumstances, but may be more effective provided that both IFN-α and γ can be administered exactly according to this regimen by improving measures against their toxicities.

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Purpose: To evaluate the clinical relevance between the DNA ploidy and histopathology, and the incidence of the DNA heterogeneity in patients with bladder cancers.
Methods: Flow cytometry (FCM) was used to study the DNA ploidy in 63 patients who underwent total cystectomy. The DNA ploidy and DNA index were analyzed by FCM in total 328 paraffin embedded samples (5.2 samples per case on the average).
Results: The DNA ploidy of 52 bladder cancers, that had coexisted after total cystectomy, showed that 24 cases, 46% were DNA aneuploid and 18 cases, 35% had DNA heterogeneity. The DNA ploidy of 11 cases that were eradicated after cystectomy was all DNA diploid. There were significantly good correlation among DNA ploidy pattern and intravesical involvement (lymphduct involvement and venous involvement), but were not among the DNA ploidy pattern and tumor grade and stage. With regard to the evaluation of two vertical deviled samples of tumors, DNA aneuploid had been not always recognized in the deeper sample, therefore, we did not determine that there was good correlation between the DNA ploidy and the tumor invasion.
Conclusion: These data suggest that although the incidence of DNA heterogeneity in bladder cancers (35%) is thought to be relatively small, the DNA ploidy will be able to the important prognosticating factor in bladder cancers.

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Isometric contractile force of rabbit prostatic tissue in response to electric field stimulation (EFS), KCl, and phenylephrine were measured at incubation temperature of 37°C, before and after thermal exposure to 42°C, 45°C, 48°C and 50°C for 30 minutes. The contractile force in response to EFS decreased after thermal exposure above 45°C, and the contractile force in response to KCl or phenylephrine decreased after thermal exposure above 48°C. All the contractile response abolished after thermal exposure to 50°C. The results indicate that the nerve is more hears-ensitive than the smooth muscle in the prostate. Histological examination revealed shrinkage of cell body and dark stainig of nuclear chromatin of the smooth muscle cells after thermal exposure above 48°C. The same histological change of the smooth muscle as well as degenerative change of the nerve cells was observed on the prostate 3-7 months after clinical thermotherapy. From these results, it is suggested that clinical effect of thermotherapy is brought about from both neural and muscular damage of the prostate. Since the least temperature to cause an irreversible tissue damage ranges from 48°C through 50°C, we believe it is ideal to heat the prostate around 50°C to obtain a good clinical effect of thermotherapy on benign prostatic hyperplasia as a minimum invasive treatmant.

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It is known that serum prostate specific antigen (PSA) in urinary retention due to benign prostatic hypertrophy (BPH) increase. To evaluate prognostic value of the ratio of serum PSA to γ-seminoprotein (P/S Ratio) for prostate cancer (PC) in patients with urinary retention, we have studied the P/S Ratio at the initial examination in 33 patients with untreated PC (10 with and 23 without urinary retention) and 193 patients with untreated BPH (38 with and 155 without urinary retention) histopathologically diagnosed at our hospital between January, 1992 and December, 1993.
The results were as follows:
1) The mean P/S ratio of PC patients was significantly higher than that of BPH patients in both groups with and without urinary retention.
2) When the cut off value of P/S Ratio was determined to be 1.35, the highest efficiency, 59.3% was obtained in the group without urinary retention. The sensitivity and specificity were 65.2% and 91.0%.
3) In the group with urinary retention, the efficiency was also the highest, 80.0% with a cut off value of 1.35. The sensitivity and specificity were 80.0% and 100%.
4) In all patients, the efficiency was 64.6%, the sensitivity was 69.7%, and the specificity was 92.7% with a cut off value of 1.35.
5) Positive rate of serum PSA in BPH patients with urinary retention was 47.4% and that in BPH patients without urinary retention was 17.4%. The mean P/S ratio of the BPH patients with urinary retention was significantly lower than that of BPH patients without urinary retention, which suggested that the serum free PSA increase in the former.
P/S Ratio is useful means of diagnosis for PC especially in patients with urinary retention.

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Clinical investigation of 93 patients with histologically confirmed renal pelvic and ureteral cancer were performed. These patients consisted of 55 males and 38 females with a mean age of 64.8 years. There were 61 cases of renal pelvic cancer, 55 cases of ureteral cancer and 23 with cancers of both sites. Thirty-four cases were associated with bladder cancer and 41 of 82 patients had multiple tumors. The overall 5-year survival rate was 46.0%. 5-year survival of stages pTa, pT1, pT2, pT3, and pT4, was 93.3%, 71.8%, 37.5%, 30.4% and 10.5%, respectively. In this report, we evaluated various prognostic factors according to the survival rate. Sex, age, tumor localization, multiplicity, associated bladder cancer and concomitance of CIS had no influence on survival. In the ABC analysis, the B group showed a tendency for a poor prognosis. However it may be explained from the fact that the B group contained more patients at advanced stages than the other groups. Tumor grade, tumor stage, pV factor and pL factor had a significant effect on survivals. But tumor grade, pV and pL factors were closely related to the tumor stage. Thus the stage was thought to be the most important factor in the prognosis of upper urinary tract cancer. Different surgical procedures and irradiaion also did not affect the prognosis of the patients with the same degree of invasion. Chemotherapy for all stages had no effect on survivals compared with non-chemotherapic group. However only for pT3 and higher stage cases, cisplatin-based chemotherapy improved the prognosis compared with patients not given chemotherapy.
In conclusion, chemotherapy containing cisplatin should be considered for treatment of high stage upper urinary tract cancer.

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We investigated the incidence of associated bladder tumor and prognosis in 101 cases with a pathological diagnosis of transitional cell carcinoma, selected from those with renal pelvic and ureteral tumor whom we had encountered over the 18 years between April 1976 and March 1993. Among these 101 cases, the incidence of associated bladder tumor was noted in 42 (41.6%), 23 (22.8%) with coexistence and 19 (18.8%) with subsequence. As for the primary site of renal pelvis and ureter, the coexistence was 15.4% and subsequence 20.5% in renal pelvis, and the coexistence was 24.6% and subsequence 19.3% in ureter, and the coexistence was 60.0% and subsequence 0.0% in both renal pelvis and ureter. The incidence of coexistent bladder tumor was high in both renal pelvis and ureter, but no significant difference was noted. As for the stage, the incidence of coexistence was high in T₁, while subsequence was high in T₂, but no significant difference was noted. As for the grade, the incidence of coexistence was high in G₂, but no significant difference was noted. The 5 year survival rate was 58.2% in those without, 54.2% with coexistence, and 82.5% with subsequent bladder tumor, with a significant difference (p<0.05) between the last two groups. The interval of subsequent bladder tumor ranged from 4 to 164 months (mean 27.7 months), with the incidence within 2 years being approximately 70.0%.
It was found that the renal pelvic and ureteral tumors are frequently associated bladder tumor while associated bladder tumor dose not appear to have an ill effect on the prognosis. Therefore it is necessary that patients with renal pelvic and ureteral tumor be observed closely for 5 years, especially for the initial 2 years.

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Anorectal malformation (ARM) is often associated with urological problems such as congenital urogenital anomalies, recto-urinary fistula, neurogenic bladder due to vertebral anomalies and operative complications. We analized 57 cases of ARM and discussed about the management of associated urogenital anomalies during neonatal and infantile period. The incidence of urogenital anomalies was 85.7% in high type, 65.5% in intermediate type and 38.1% in low type. Among these urinary tract anomalies, VUR was most common and was documented in 38.6% of ARM patients. Renal dysplasia, PUJ stenosis, megaureter and urethral stenosis was also common in these patients. Renal dysfunction was documented in 5 cases (2 in high type, 2 in intermediate and 1 in low type), mainly due to VUR and renal aplasia. These results show the need for evaluation of urinary tract during the neonatal and early infantile period even in low type ARM. The management of urinary tract anomalies associated with ARM is firmly related with the management of ARM itself, and we must be closely in co-operation with pediatric surgeons.

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We experienced a case of renal hamartoma of mesothelial origin. A 21-year-old woman was refered to our hospital with a complaint of growing abdominal mass. The diagnosis of right renal tumor was confirmed based on the radiographic examinations. The renal tumor was removed by partial nephrectomy. Histological examination revealed the tumor composed of fibloblasts, smooth muscle and a few tubule-like epithelial tissue. Thus, this case was classified as renal hamartoma of mesothelial origin.

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.A 47-year-old man presented with a 10-year history of left scrotal swelling. No solid mass detected on sonogram, dark-red colored fluid aspirated, equivocal cytology, and elevated serum CA19-9 level prompted surgical exploration. Frozen section reported no malignancy of thickening of the tunica vaginalis. The final pathology adenocarcinoma, however, necessitated left radical orchiectomy and hemiscrotal resection, demonstrating no malignancy at the left testis nor epididymis. CA19-9 level was high (104, 200U/ml) in the fluid obtained at the first surgery and the tumor cells were positively stained for CA19-9. Imaging study including abdominal CT scan and upper G-I series and normalization of CA19-9 level denied other tumor existing. In conclusion, this is to our knowledge the first case report of adenocarcinoma of the tunica vaginalis expressing CA19-9 antigen

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A case of squamous cell carcinoma of the ureter was reported.
A 62-year-old woman, who underwent left nephrectomy and right ureterocutaneostomy at the age of thirty-one because of tuberculosis of the urinary tract, visits our hospital periodically for an ureteral catheter change. An urgent nephrostomy was performed because of ureteral stricutre on March, 8, 1994. Three months later tenderness and induration appeared at the former ureteral stoma. The resected specimen was histologically diagnosed as squamous cell carcinoma. Right palliative ureterectomy did not produce the desired effects due to the invasion of the tumor into the sorrounding organs.
In this rare case, it is suggested that chronic infection and irritation of the indwelling catheter might be causative of squamous cell carcinoma of the ureter.

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